Baby Marian is only 30 seconds old. Wrapped in a thin shawl and placed next to her mother on a rickety iron bed, she faces a hard life.

Her mother, Tosha Sangan, 32, fled violence in the Democratic Republic of the Congo (DRC) 15 years ago and found safety at the sprawling Nyarugusu refugee camp in Tanzania.

The camp’s main hospital offers little comfort or privacy, but it is a lifeline for hundreds of thousands of refugees like Tosha, and Tanzanians who live nearby.

However, a severe funding shortage means it is struggling to meet demand.

With just 121 beds, two doctors and five assistant doctors, the hospital handles more than 7,000 outpatients per month: more than 6,000 refugees and 1,000 Tanzanians.

"The doctors said the malaria had gone all
the way to his brain."

Every bed is occupied, sometimes by two patients, and there is a serious shortage of medicine because of importation difficulties. In a camp with a population of 150,000, of whom 80 per cent are women and children, every day is a struggle to save lives.

Susana Kahoto is from Burundi and her son lost the battle.

“My child came down with a fever,” she says. “He kept being sick and had diarrhoea. I took him to the hospital, where they did some tests on him and discovered he had malaria. The doctors said the malaria had gone all the way to his brain. I went with him to the emergency ward and he died. I feel heartbroken.”

Jackson John, 26, has been working as a midwife at the hospital for four months. Today, he is helping to nurse a tiny baby born at 32 weeks and weighing just under 2.5 kilograms. For the Tanzanian mother, Verine Shimirimara, this is the nearest hospital – without it, she would have had to travel 30 kilometres to give birth.

Funding is urgently needed to keep it running. “We are sometimes out of stock of essential drugs and supplies,” says Jackson. “The local market just cannot meet the need.”

Jackson points to a large square of paper tacked to the wall that lists equipment supplies. They are desperately low. In this maternity ward alone, with nine beds at full occupancy, he and the doctors must share just one oxygen machine, two small delivery beds, two pairs of forceps and one stethoscope. The hospital’s single ultrasound machine needs repair.

“I’ve been working at this hospital for 10 years,” says Dr. Florence from the Tanzanian Red Cross Society. "In that time, I’ve seen it get worse, especially after the 2015 influx from Burundi. Malaria is our biggest issue. We have the medicine, but the supply is inconsistent. We usually get around 600 patients a day and, when it rains, it increases to 900.”

Added to this, cuts in food rations mean acute malnutrition has risen from 1 per cent to 2.4 per cent in Nyagurusu camp.

"We have the medicine, but the supply is inconsistent."

Ebinda Nyota, 62, came to Nyarugusu 20 years ago to escape war in the DRC and now works at the hospital as a traditional birth attendant, who provides basic health care for new mothers and their babies. She often comes to work hungry. “It is difficult,” she says. “At home we had fish and meat. Here it is just flour and maize.”

UNHCR, the UN Refugee Agency, is working hard to improve and expand health services at Nyarugusu camp. An extension to the main hospital’s maternity ward, due to finish at the end of December, will mean four more delivery beds.

At a hospital which serves not only refugees, but also the local Tanzanian population, projects like these are vital and form part of efforts by the Tanzanian government, UNHCR and partner organizations to implement a broad refugee response known as the Comprehensive Refugee Response Framework (CRRF).

However, much more is needed and a funding shortfall of US$98.7 million for UNHCR’s Tanzania operation is hampering efforts.

“UNHCR is looking at providing health services to both the refugee and the host communities” says Måns Fellesson, CRRF coordinator. “By linking humanitarian and development efforts early on, we aim for a sustainable response to common challenges.”

For mothers like Tosha and newborn babies like Marian, Nyarugusu’s hospital has changed their lives.

“I’ve had all five of my children here,” says Tosha, cradling Marian. “It’s a difficult life, but I am so thankful for the assistance of UNHCR and the medical workers.”